As the number of patients getting value-based healthcare doubles, many more high-risk patients are excluded. EMMT is a potential bipartisan solution. Episode 143.

The Health Disparities Podcast

Jun 6 2023 • 29 mins

Value-based care has emerged as an alternative and potential replacement for traditional fee-for-service reimbursement, centering quality and outcomes rather than quantity. That is the theory.

In practice, value-based care has been shown to exacerbate some disparities in the healthcare system by making it harder for those patients with complex conditions, or being impacted by social determinants of health, to access care. Put simply, if some categories of patient are more financially risky than others to treat, providers may find ways to exclude them – unless checks and balances are put in place to help manage risks associated with SDOH and comorbid conditions.

Health policy expert Matt Reiter hosts a discussion featuring Bill Finerfrock from Capitol Associates, and Tom Dorney from The Root Cause Coaltion. Together they discuss the very real danger of widening health disparities resulting from the expansion of value-based care, and the legislative solution proposed by the John Lewis EMMT Act (Equality in Medicare and Medicaid Treatment) which has been reintroduced in 2023 by Rep. Teri Sewell and Sen. Cory Booker.

All organizations advocating for health equity are encouraged to help advance the legislation by writing letters of support (template below) to Matt Reiter reiterm@capitolassociates.com who will coordinate their forwarding to Representative Sewell and Senator Booker.

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LETTER OF SUPPORT TEMPLATE

Dear Representative Sewell & Senator Booker,

I am writing in support of S.1296/H.R.3069, the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act of 2023.

The EMMT Act would require the Center for Medicare and Medicaid Innovation (CMMI) to include experts in health disparities and social determinants of health as part of the evaluation and review process for new payment models. If enacted, this bill would also require fairness of these new payment methods for women, high-risk patients, patients from racial or ethnic minorities, or patients from rural communities. Lastly, it directs CMMI to develop and test a payment model that is tailored to addressing social determinants of health.

While quality and cost are important considerations, equal consideration should be given to the impact a proposed model may have on access to care for women, minorities and beneficiaries residing in rural areas. CMMI is under no statutory obligation to account for social determinants of health when considering new payment models. Indeed, the only factors CMMI must consider when determining whether to approve a new payment model are quality and cost.

Because Medicare is the single largest health care payer in the country, and many commercial insurance plans will adopt policies based on Medicare, Congress must ensure that the models approved by CMMI incentivize reductions in minority and rural health disparities and not create barriers to care. We appreciate all that this CMS Administration has done to advance health equity. Passing the EMMT Act will ensure that all new models account for social determinants of health and how the models impact minority and rural populations.

Your leadership on eliminating health disparities for women, minorities and beneficiaries residing in rural areas is deeply appreciated.

I applaud your leadership on this important bill. The EMMT Act will go a long way towards improving access to quality healthcare for Medicare and Medicaid beneficiaries.

On behalf or our organization:

Sincerely,

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Health Disparities Podcast Episode 143 (c) Movement is Life 2023